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Implications for Policy and Programming: Reflections from the RENEWAL Study, 2008
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Implications for Policy and Programming: Reflections from the RENEWAL Study, 2008


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  • 1. Implications for Policy and Programming: Reflections from the RENEWAL Study, 2008 Scott Drimie, Girma Kassie & Jo Vearey University of the Witwatersrand Forced Migration Studies Programme Health and Migration Initiative
  • 2. Urban complexity opportunities for aligned policy responses
    • Health systems
    • Urban planning
    • Environmental health
    • Social protection
    • Food systems
    • Tiers of government: local – provincial – national – regional - global
  • 3. Studies Confirm Complex Urban Rural Linkages
  • 4. Nutrition and Informal Settlements
    • Implications for policy and programming
    • Johannesburg as a case study
    Urban informal settlements have double the HIV prevalence of urban formal areas in South Africa
  • 5. Dietary Diversity Score
    • A variety of foods in the diet is required to ensure an adequate intake of essential nutrients . Dietary diversity reflects the number of foods or food groups eaten over a reference period.
    • Dietary diversity can be used as an indicator of micro-nutrient adequacy (Steyn et al 2006), and as a proxy measure of the nutritional quality of the diet (Swindale and Bilinsky 2005).
    • Dietary diversity scores have been positively associated with the nutritional status of young children (Arimond and Ruel 2004) and adults (Savy et al 2007), independent of socio-economic factors.
  • 6. Addis Ababa
  • 7. Dietary Diversity Score:
  • 8. Dietary Diversity Score: respondents residing informally were more likely to have a deficient dietary score Chi-square 89.880; p = <0.0001 Score 0 - 3 Score 4 - 6 Score 7 - 9 24 hour Dietary Diversity Score
  • 9. [1 GAIn, 2009 ; Steyn et al. 2005 ; Kruger et al. 2007 Comparison of stunting (low height-for-age) for children aged 1-9 years nationally and by area of residence: South Africa 1999 and 2005 Steyn  et al (2006) showed a strong relationship between dietary diversity and child growth for South African children.
  • 10. An Inadequate Diet: Some Issues
    • Refined foods among lowest cost sources of energy; more nutrient dense foods (lean meat, vegetables and fruit) are more costly.
    • In 2006 many healthier food items were 50% more expensive than comparable less healthy ones.
    • Low-income people will often select a diet with a high content of refined cereals, sugar and fat (Temple & Steyn, 2009).
    • Suggests economic factors may lead to selection of unhealthy diet. However, other factors such as taste and convenience are important.
  • 11. Implications of an Inadequate Diet
    • High content of sugar and fat in cheap, less healthy foods causes them to have high energy density (ED)
    • Many investigators speculate that diets with high ED may be responsible for high prevalence of obesity in people of low socio-economic status.
    • South Africa has a high prevalence of both under-nutrition (micronutrient deficiencies in infants and children) and over-nutrition. Poor quality of available food may contribute to both conditions.
  • 12. HIV/AIDS and nutrition are inextricably interrelated, particularly in Africa
    • Malnutrition and food insecurity are endemic in Africa, where more than 25 million people are living with HIV
    • Nearly 40% of African children < 5 are moderately or severely stunted
      • > 50% also suffer from micronutrient deficiency disorders
    • Malnutrition is not limited to children
      • > 50% of all pregnant women are anemic
  • 13. What can be done?
    • Food access: costs of improving diets a challenge.
    • Temple and Steyn, 2009:
    • Extra cost of a healthier diet was roughly R198 per month, an amount that represents between 10% and 20% of the entire family budget (Khayelitsha, South Africa)
    • Based on food price data collected in 2006.
    • Short sighted to advise people to change diets if unaffordable.
  • 14. What can be done?
    • Food availability: urban agriculture may contribute to urban diets
    • Major challenges in Johannesburg and Windhoek:
    • Cost of water, availability of land, weak extension/ support, weak markets, spatial planning (“Apartheid City”), poor sectoral integration
    • However, there seems to be growing interest (food prices) and there are important lessons from Addis Ababa
    • Short sighted to advise people to change diets if unaffordable
  • 15. What can be done?
    • Food utilisation: Health promotion messages formulated to advise selection of foods that are healthy and affordable – including maize meal, oats, lentils, rice, dry beans, vegetables and fruit.
    • But what about broader structural issues? – challenge of addressing the reality of food prices. Address through:
    • Taxation? Subsidies? Disincentives for price collusion?
    • These elements of food insecurity cannot be taken in isolation
  • 16. An Aligned Approach?
  • 17. Implications and challenges
    • Considering the interlinked livelihood systems, what interventions are required…….
      • To improve conditions for poor urban households to create sustainable livelihoods with positive health and food security outcomes?
      • To support poor urban households to mitigate the negative impact of chronic illness?